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Patrick Sullivan
Infant's death another nail in circumcision's coffin, group says
CMAJ 2002; 167: 789-a [Full text] [PDF]
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[Read eLetter] Proceed with Caution!
George Hill   (5 October 2002)
[Read eLetter] Colleges should declare a moritorium on routine infant circumcision
Lawrence E Barichello   (3 October 2002)

Proceed with Caution! 5 October 2002
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George Hill,
Executive Secretary
Doctors Opposing Circumcision

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Re: Proceed with Caution!

iconbuster{at}eatel.net George Hill


Dear Editor:

      The Canadian Medical Protective Association (CMPA) "advises members that a thorough informed consent discussion must take place with the parent(s) and be well documented."1 This is excellent advice if parents actually have the power to consent to non-therapeutic circumcision.

      Whether parents actually have the power to consent to non-therapeutic circumcision of a child is far from clear. The Supreme Court of Canada has drawn a protective legal veil over the genital organs of children. In the case of E (Mrs) v. Eve,2 the court denied the application of the mother to sterilize an incompetent girl. Such operations can never be carried out for the benefit of the parents.2

      Male neonatal circumcision is comparable to the sterilization of an incompetent female because both involve invasive non-therapeutic surgery on the genital organs of a legally incompetent person with the intent of permanently altering the form and function of those organs. If the Eve ruling is applied to male neonatal circumcision, parents would lack power to consent to a non-therapeutic circumcision.

      Several law journal articles argue that, if parents lack power to consent to a non-therapeutic circumcision, then consent for circumcision would be vitiated, without power or effect.3,4 Circumcision of a child, in that case, would be a battery.3,4

      Male circumcision is a radical procedure that permanently and irreversibly excises functional tissue from the genital organs.5 The Committee on Medical Ethics of the British Medical Association advises that good practice requires doctors should first try conservative treatment before advising a circumcision.6 Unfortunately, we find that North American doctors are woefully ignorant of conservative treatments commonly used in Europe.

      The need for an operation on an incompetent person must be proved. The Eve court observed:

Since, barring emergency situations, a surgical procedure without consent ordinarily constitutes battery, it will be obvious that the onus of proving the need for the procedure is on those who seek to have it performed.2

      Doctors would do well to limit the circumcision of male children to those rare cases in which a genuine documented immediate therapeutic need exists and for which conservative treatment is not effective.

George Hill, Executive Secretary
Doctors Opposing Circumcision
Suite 42
2442 NW Market Street,
Seattle, Washington 98107
Web: http://www.doctorsopposingcircumcision.org

Reply to: iconbuster{at}eatel.net

References:

  1. Sullivan P. Infant’s death another nail in circumcision’s coffin, group says. CMAJ 2002;167(7):789.
  2. E. (Mrs.) v.Eve, [1986] 286 S.C.R. 388.
  3. Boyle GJ, Svoboda JS, Price CP, Turner JN. Circumcision of boys: criminal assault? J Law Med 2000;7:310-10.
  4. Svoboda JS, Van Howe RS, Dwyer JG. Informed consent for neonatal circumcision: an ethical and legal conundrum. J Contemp Health Law Policy 2000;17:61-133.
  5. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-295.
  6. Committee on Medical Ethics. Circumcision of Male Infants: Guidance for Doctors. London: British Medical Association, 1996.
    7.

Colleges should declare a moritorium on routine infant circumcision 3 October 2002
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Lawrence E Barichello,
Executive Director
Intact

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Re: Colleges should declare a moritorium on routine infant circumcision

lawrence{at}intact.ca Lawrence E Barichello

Dear Editor:

In light of the recent tragic death of an infant in BC, we are well advised to remember the following:

The Canadian Paediatric Society (CPS) advised in 1996, “Circumcision of newborns should not be routinely performed.”1

The Canadian Medical Association’s Code of Ethics says physicians must “Consider first the well-being of the patient.”2 Male neonatal non-therapeutic circumcision at parental request places the parents' desires above the well-being of the patient, and so is unethical.

The Netherlands Institute of Human Rights reminds us that "One of the most important aspects in determining whether a cultural practice can be deemed to be a violation of human rights is the extent to which innocent people are wounded or killed as a result of that practice."3

Non-therapeutic neonatal circumcision is an infringement of the child's human rights guaranteed by sections 7, 15, and 28 of the Charter of Rights and Freedoms.4 The Code of Ethics says physicians should “Refuse to participate in or support practices that violate basic human rights.”5

The College of Physicians and Surgeons of Saskatchewan issued its memorandum in February - more than seven months ago - to protect the public from unnecessary circumcision and doctors from unnecessary litigation.6 The other provincial colleges have had ample time to act, but have failed to do so. The provincial colleges of physicians and surgeons have a general duty under law to protect the public. Surely, this includes protecting the public from unnecessary1,7 and dangerous8,9 excision of healthy functional tissue10,11 carried out on minor children.

Bhimji declares that infant circumcision is not only harmful to the baby, but to all of Canadian society.4

Each provincial college of physicians and surgeons should immediately declare a moratorium on routine infant circumcision until such time as it can develop a guidance for doctors consistent with the the CPS circumcision statements, the Code of Ethics, international human rights law, and the Canadian Charter of Rights and Freedoms.

Sincerely,

Lawrence E. Barichello
Executive Director
Intact
P. O. Box 31016
RPO College Sq
Toronto, ON          M6G 4A7
(416) 530-4810


References:

  1. Fetus and Newborn Committee, Canadian Paediatric Society (CPS). Neonatal circumcision revisited. Can Med Assoc J 1996; 154(6):769-780.
  2. Code of Ethics. Ottawa: Canadian Medical Association (1996), § 1.
  3. Smith J. Male Circumcision and the Rights of the Child. In: Mielle Bulterman, Aart Hendriks and Jacqueline Smith (Eds.), To Baehr in Our Minds: Essays in Human Rights from the Heart of the Netherlands (SIM Special No. 21). Netherlands Institute of Human Rights (SIM), University of Utrecht, Utrecht, Netherlands, 1998: pp. 465-498.
  4. Bhimji A. Infant male circumcision: a violation of the Canadian Charter of Rights and Freedoms. Health Care Law 2000; January 1:1-33. (requires Acrobat Reader)
  5. Code of Ethics. Ottawa: Canadian Medical Association (1996), § 33.
  6. Kendel DA. Caution Against Routine Circumcision of Newborn Male Infants (Memorandum to physicians and surgeons of Saskatchewan). Saskatoon: College of Physicians and Surgeons of Saskatchewan, February 20, 2002. Photocopy.
  7. Denniston GC. Unnecessary Circumcision. The Female Patient 1992:17:13-14.
  8. Gellis SS. Circumcision. Am J Dis Child 1978;132:1168.
  9. Baker RL. Newborn male circumcision: needless and dangerous. Sexual Medicine Today 1979;3(11):35-36.
  10. Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Inf 1998;74:364-367.
  11. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44.